scholarly journals Compound A concentration is decreased by cooling anaesthetic circuit during low-flow sevoflurane anaesthesia

1998 ◽  
Vol 45 (12) ◽  
pp. 1215-1218 ◽  
Author(s):  
Masami Osawa ◽  
Tetsutaro Shinomura
Keyword(s):  
Low Flow ◽  
Compound A ◽  
Sevoflurane Anaesthesia ◽  
Anaesthetic Circuit

Effects of the Water Content of Soda Lime on Compound A Concentration in the Anesthesia Circuit in Sevoflurane Anesthesia 

1998 ◽  
Vol 88 (1) ◽  
pp. 66-71 ◽  
Author(s):  
Hiromichi Bito ◽  
Yukako Ikeuchi ◽  
Kazuyuki Ikeda
Keyword(s):  
Gas Flow ◽  
Soda Lime ◽  
Absorption Capacity ◽  
Low Flow ◽  
Co2 Absorption ◽  
Sevoflurane Anesthesia ◽  
Compound A ◽  
Carbon Dioxide Co2 ◽  
End Tidal ◽  
Co2 Elimination

Background Sevoflurane anesthesia is usually performed with fresh gas flow rates greater than 2 l/min due to the toxicity of compound A in rats and limited clinical experience with sevoflurane in low-flow systems. However, to reduce costs, it would be useful to identify ways to reduce compound A concentrations in low-flow sevoflurane anesthesia. This goal of this study was to determine if compound A concentrations can be reduced by using soda lime with water added. Methods Low-flow sevoflurane anesthesia (fresh gas flow of 1 l/min) was performed in 37 patients using soda lime with water added (perhydrated soda lime) or standard soda lime as the carbon dioxide (CO2) absorbent. The soda lime was not changed between patients, but rather was used until CO2 rebreathing occurred. The perhydrated soda lime was prepared by spraying 100 ml distilled water onto 1 kg fresh soda lime, and water was added only when a new bag of soda lime was placed into the canister. Compound A concentrations in the circle system, soda lime temperatures, inspired and end-tidal CO2 and end-tidal sevoflurane concentrations, and CO2 elimination by the patient were measured during anesthesia. Results Compound A concentrations were significantly lower for the perhydrated soda lime (1.9 +/- 1.8 ppm; means +/- SD) than for the standard soda lime (13.9 +/- 8.2 ppm). No differences were seen between the two types of soda lime with regard to the temperature of the soda lime, end-tidal sevoflurane concentrations, or CO2 elimination. Compound A concentration decreased with the total time of soda lime use for both types of soda lime. The CO2 absorption capacity was significantly less for perhydrated soda lime than for standard soda lime. Conclusions Compound A concentrations in the circuit can be reduced by using soda lime with water added. The CO2 absorption capacity of the soda lime is reduced by adding water to it, but this should not be clinically significant.

scholarly journals Cost-effectiveness of Basal Flow Sevoflurane Anaesthesia Using the Komesaroff Vaporizer inside the Circle System

2005 ◽  
Vol 33 (5) ◽  
pp. 609-615 ◽  
Author(s):  
S. P. Nandalan ◽  
R. J. Eltringham ◽  
Q. W. Fan
Keyword(s):  
Gas Flow ◽  
Low Flow ◽  
Gas Flows ◽  
Physical Status ◽  
Mechanically Ventilated ◽  
Sevoflurane Anaesthesia ◽  
Inspiratory Limb ◽  
Low Flow Anaesthesia ◽  
Induction Of Anaesthesia ◽  
Basal Flow

After ethics committee approval, 51 consenting ASA physical status 1 or 2 adult patients were given basal flow sevoflurane anaesthesia using fresh gas flows of 150 to 300 ml.min-1 oxygen. A Komesaroff vaporizer was placed on the inspiratory limb of the circle system. Basal flows were introduced immediately following intravenous induction of anaesthesia. The vaporizer was set to deliver the maximum concentration until the inspired sevoflurane concentration (FSI) reached 3%. The dial was then adjusted to maintain the FSI at 3%. After every 60 minutes, the circuit was washed out with 100% oxygen at a flow rate of 10 l.min-1 for one minute. The FSI reached 3% after an average of 8.5 (3.8) [mean (SD)] minutes. The trends in FSI and the expired sevoflurane concentrations were significantly different (P<0.05) between the mechanically ventilated patients (n=21) and the spontaneously ventilating patients (n=30) and demonstrated a more gradual build-up in the former group. The consumption of sevoflurane was found to be 9.2 (2.8) ml.h-1. This represented a 52.5% cost saving over the clinical application of the Mapleson's ideal fresh gas flow sequence for low-flow anaesthesia.

Compound A Concentration in the Circle Absorber System during Low-Flow Sevoflurane Anesthesia Comparison between Drägersorb Free®, Amsorb® and Sodasorb II

2002 ◽  
Vol 96 (Sup 2) ◽  
pp. A83
Author(s):  
Shunji Kobayashi ◽  
Hiromichi Bito ◽  
Yukako Obata ◽  
Takasumi Katoh ◽  
Shigehito Sato
Keyword(s):  
Low Flow ◽  
Sevoflurane Anesthesia ◽  
Compound A ◽  
Circle Absorber

Compound A concentration and the temperature of CO2 absorbents during low-flow sevoflurane anesthesia in surgical patients

1995 ◽  
Vol 9 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Masami Osawa ◽  
Tetsutaro Shinomura ◽  
Masahiro Murakawa ◽  
Kenjiro Mori
Keyword(s):  
Surgical Patients ◽  
Low Flow ◽  
Sevoflurane Anesthesia ◽  
Compound A

Effects of Probenecid on Renal Function in Surgical Patients Anesthetized with Low-flow Sevoflurane

2001 ◽  
Vol 94 (1) ◽  
pp. 21-31 ◽  
Author(s):  
Hideyuki Higuchi ◽  
Hiroki Wada ◽  
Yumi Usui ◽  
Kohichiro Goto ◽  
Masuyuki Kanno ◽  
...  
Keyword(s):  
Urinary Excretion ◽  
Biochemical Markers ◽  
High Flow ◽  
Surgical Patients ◽  
Low Flow ◽  
Sevoflurane Anesthesia ◽  
Compound A ◽  
Significant Difference ◽  
Beta 2 ◽  
Beta 2 Microglobulin

Background Dehydrofluorination of sevoflurane by carbon dioxide absorbents in anesthesia machines produces compound A, which is nephrotoxic in rats. Several clinical studies indicate that prolonged low-flow sevoflurane anesthesia is associated with an increased urinary excretion of biochemical markers, such as protein. Probenecid, a competitive inhibitor of organic anion transport, diminishes compound A nephrotoxicity in rats. The purpose of the present study was to examine the effects of low- and high-flow sevoflurane anesthesia on urinary excretion of biochemical markers in humans and to examine the effects of probenecid on urinary excretion of these markers. Methods Elective surgical patients (n = 64) were assigned to four groups (n = 16 each): low-flow sevoflurane plus probenecid (LSP), low-flow sevoflurane (LS), high-flow sevoflurane plus probenecid (HSP), and high-flow sevoflurane (HS). Probenecid (2.0 g) was administered orally 2 h before the induction of anesthesia in both the LSP and HSP groups. Nothing was administered orally 2 h before the induction of anesthesia in either the LS or HS groups. All patients underwent prolonged low-flow (1 l/min) or high-flow (6 l/min) sevoflurane anesthesia. Urinary excretion of protein, albumin, beta(2)-microglobulin, glucose, and N-acetyl-beta-d-glucosaminidase was measured for up to 7 days postoperatively. Results Sevoflurane doses were similar in all four groups. There were no differences in blood urea nitrogen, creatinine, or creatinine clearance among the four groups after anesthesia. Average values for urinary excretion of protein, beta(2)-microglobulin, and N-acetyl-beta-d-glucosaminidase in the LS group were significantly higher than those in the other groups (LSP, HSP, HS; P &lt; 0.05). There was no significant difference between the LS and LSP groups in average values for urinary excretion of albumin and glucose, although there were significant differences between the LS and both high-flow sevoflurane groups (HSP, HS). Conclusions Low-flow sevoflurane, which produces a sevenfold higher compound A exposure than high-flow sevoflurane, resulted in significant increases of several biochemical markers in half of the patients. Probenecid appears to provide protection against these renal effects.

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